Building on progress against pancreatic cancer

Nationally, only about 9% of people diagnosed with pancreatic cancer survive five years. In most cases, the disease has spread to other organs by the time it’s discovered.

Surgery is the standard of care when the tumor is surgically removable, but even then the median survival for such patients is about 22 months.

At MD Anderson, it’s 43 months, the result of a shift toward routine presurgical treatment and steady improvements in imaging, surgery, radiation, chemotherapy and other specialties built through multidisciplinary teamwork in research and clinical trials over the past 25 years. Now, MD Anderson’s Pancreatic Cancer Moon Shot™ adds analytical capabilities.

How to make surgery more successful

Less toxic chemotherapy combinations and targeted radiation before surgery can improve the prospects of patients whose tumors might once have gone to surgery first, says Robert Wolff, M.D., professor of Gastrointestinal Medical Oncology, also a Moon Shot co-leader and Sheikh Zayed Bin Sultan Al Nahyan Distinguished University Chair in Medical Oncology.

Safer and more effective surgical techniques as well as improvements in care right before, during and after surgery have been critical in improving survival.

“Our mortality within 90 days of surgery is essentially 0% of patients, and our length of hospital stay after surgery is six days,” Katz notes.

Nationally, the surgery-related death rate is about 8%, and the post-surgical hospital stay is over 10 days.

Presurgical treatment also is used to shrink more locally advanced tumors to make them removable, Wolff says. Careful assessment helps ensure the disease has not spread to other organs, because surgery is futile then.

What works and why just for some

Understanding why patients like Lusby do well and why treatment is less effective for others is central to improving results for patients with non-metastatic disease.

Deep molecular analysis of blood and tumor samples will help the team address these issues.

The newest member of the team is Joseph Herman, M.D., interim division head of Radiation Oncology and an expert in an abbreviated radiation treatment for the pancreas known as stereotactic body radiation therapy (SBRT). SBRT has a similar or sometimes better effect than conventional radiation but is administered over five days instead of six weeks, allowing for shorter stays for MD Anderson’s out-of-town patients. The therapy delivers high doses of radiation, using several beams of varying intensities aimed at different angles to precisely target the tumor.

“This precise targeting of the tumor has less effect on surrounding organs, so there’s limited toxicity,” Herman says. “Conventional radiation requires concurrent chemotherapy and can lead to more toxicity because it usually includes a larger volume of radiation over time. SBRT uses a smaller, more focused volume and therefore can be easier on patients’ immune systems.

“Through the Moon Shot, we’ll be looking to improve SBRT for pancreatic cancer,” says Herman, a pioneer in the use of the targeted radiation for the disease.

Learn more about MD Anderson’s team approach to pancreatic cancer in Conquest magazine.